혈압강하, 어디까지 좋은가?

Abstract

In general, each increase of 20/10 mmHg (systolic to diastolic) blood pressure (BP) above 115 mmHg and 75 mmHg results in a two-fold increased risk for cardiovascular complications. In addition, cerebrovascular events in association with hypertension are more frequent than myocardial infarctions in Asian populations. To prove the correlation between cardiovascular events and hypertension observed in the observational studies, BP-lowering studies should be performed to demonstrate the preventive effect on cardiovascular events. However, no randomized clinical studies to date have been able to prove the preventative effects of BP lowering in the blood pressure around 140/90 mmHg or mild hypertension. Despite the fact that many guidelines, including Joint National Committee-7 guidelines, recommend BP lowering for those ranges of blood pressure. In recent years, there have been many contradictory hypotheses about the asymmetry between the results from observational studies and clinical trials, which have led to the establishment of representative studies to set new target BPs. Such studies have proven the benefits of BP lowering closer to optimal blood pressure. Therefore, a discussion about applying these findings to patient care is needed. (Korean J Med 2016;90:501-506)